弥漫性大 B 细胞淋巴瘤伴精神障碍患者的死亡率：一项基于人群的研究。

Mortality among patients with diffuse large B-cell lymphoma and mental disorders: a population-based study.

机构信息

Department of Medicine, University of Toronto, Toronto, ON, Canada.

Sunnybrook Odette Cancer Centre, Toronto, ON, Canada.

出版信息

J Natl Cancer Inst. 2023 Oct 9;115(10):1194-1203. doi: 10.1093/jnci/djad149.

DOI:10.1093/jnci/djad149

PMID:37531271

Abstract

BACKGROUND

Mental disorders have been reported in patients with diffuse large B-cell lymphoma (DLBCL), but studies examining their association with mortality are lacking.

METHODS

We conducted a population-based study using linked administrative health-care databases from Ontario, Canada. All patients with DLBCL 18 years of age or older treated with rituximab-based therapy between January 1, 2005, and December 31, 2017, were identified and followed until March 1, 2020. Mental disorders were defined as either preexisting or postdiagnosis (after lymphoma treatment initiation). Cox proportional hazards models were used to estimate the adjusted hazard ratio (HR) between mental disorders and 1-year and all-cause mortality while controlling for covariates.

RESULTS

We identified 10 299 patients with DLBCL. The median age of the cohort was 67 years; 46% of patients were female, and 28% had a preexisting mental disorder. At 1-year follow-up, 892 (9%) had a postdiagnosis mental disorder, and a total of 2008 (20%) patients died. Preexisting mental disorders were not associated with 1-year mortality (adjusted HR = 1.06, 95% confidence interval [CI] = 0.96 to 1.17, P = .25), but postdiagnosis disorders were (adjusted HR = 1.51, 95% CI = 1.26 to 1.82, P = .0001). During a median follow-up of 5.2 years, 2111 (22%) patients had a postdiagnosis mental disorder, and 4084 (40%) patients died. Both preexisting and postdiagnosis mental disorders were associated with worse all-cause mortality (preexisting adjusted HR = 1.12, 95% CI = 1.04 to 1.20, P = .0024; postdiagnosis adjusted HR = 1.63, 95% CI = 1.49 to 1.79, P < .0001).

CONCLUSIONS

Patients with DLBCL and mental disorders had worse short-term and long-term mortality, particularly those with postdiagnosis mental disorders. Further studies are needed to examine mental health service utilization and factors mediating the relationship between mental disorders and inferior mortality.

摘要

背景

已有研究报道弥漫性大 B 细胞淋巴瘤（DLBCL）患者存在精神障碍，但缺乏相关死亡率的研究。

方法

我们开展了一项基于人群的研究，使用了加拿大安大略省的链接行政医疗保健数据库。所有于 2005 年 1 月 1 日至 2017 年 12 月 31 日期间接受基于利妥昔单抗治疗的年龄在 18 岁或以上的 DLBCL 患者均被纳入研究，并对其进行随访直至 2020 年 3 月 1 日。精神障碍的定义为：既往存在或诊断后（淋巴瘤治疗开始后）出现。采用 Cox 比例风险模型来估计精神障碍与 1 年和全因死亡率之间的调整后的风险比（HR），同时控制协变量。

结果

共纳入 10299 例 DLBCL 患者。队列的中位年龄为 67 岁，46%为女性，28%患者既往存在精神障碍。在 1 年随访时，892 例（9%）患者诊断后出现精神障碍，共有 2008 例（20%）患者死亡。既往存在的精神障碍与 1 年死亡率无关（调整后的 HR=1.06，95%置信区间[CI]为 0.96 至 1.17，P=0.25），但诊断后的精神障碍与 1 年死亡率相关（调整后的 HR=1.51，95%CI 为 1.26 至 1.82，P=0.0001）。在中位随访 5.2 年期间，2111 例（22%）患者诊断后出现精神障碍，4084 例（40%）患者死亡。既往存在和诊断后存在精神障碍均与全因死亡率的增加相关（既往存在的调整后的 HR=1.12，95%CI 为 1.04 至 1.20，P=0.0024；诊断后的调整后的 HR=1.63，95%CI 为 1.49 至 1.79，P<0.0001）。